Open letter on self-harm and the Online Safety Bill: A call for caution, nuance, and care

Content note: This letter discusses both self-harm and suicide, including methods, wounds, and deaths.

By Make Space, the National Survivor User Network, and Self injury Support.

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Update (February 2024): follow-up piece about influencing the Online Safety Bill, and the new Criminal Justice Bill.

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We write to express caution about the inclusion of a new self-harm related offence in the upcoming Online Safety Bill. We are concerned about the unintended consequences of such a bill on the safety and lives of people experiencing self-harm. Firstly, by opening further avenues for the criminalisation of distress, and secondly in doing so, promoting further stigma and misunderstanding about the nature of self-harm.

Here, we outline a summary of our key concerns and identify actions which may help to limit the harmful impacts of the bill on the lives of people who self-harm. Firstly, we call for malicious intent to be included as an essential requirement for prosecution. Secondly, if/when the bill passes, we ask that self-harm specific organisations are invited to develop any prosecutorial guidance. Thirdly, we encourage those reporting on the bill – in both mainstream media and by leading mental health charities who have campaigned for the bill – to do so with greater nuance and care. 

The new offence

The Online Safety Bill is a new piece of legislation expected to become law in the near future. The bill’s primary aim is to curb the distribution of harmful content online, by placing new responsibilities and legal accountability on platforms where harmful content may be distributed, and by creating a range of communications offences to criminalise those who are making such content. Included in the bill is a new offence related to self-harm – making it illegal to create content that is capable of ‘encouraging or assisting’ serious self-harm. The maximum penalty for this offence is 5 years imprisonment and unlimited fines. While it is important that the internet is a safe place for everybody (especially children and young people, about whom the bill is principally concerned), the unintended consequences of criminalising self-harm content must be considered. The bill also includes a separate offence for creating content that encourages or assists suicide, which is not the focus of our concerns here. 

Self-harm content and malicious intent 

Public communications about the bill have largely focussed on its potential to stop malicious communications about self-harm – curbing ‘abhorrent trolls’, abuse encouraging people to self-harm, and viral “suicide challenges”. We agree, these actions are wrong. However, the bill’s wording does not focus on malicious acts. Equally, the high-profile cases that sparked the campaigning for self-harm in the bill did not include bullying or trolling – instead, they seem to be the result of profit-driven algorithms which feed vulnerable users hundreds if not thousands of pieces of both self-harm and suicide related content with disregard for their safety or consent. People, especially children, deserve protection from these algorithms and platforms should be held accountable for their consequences. Moreover, nobody of any age should ever be bullied into harming themselves – whether online or offline. However, in the absence of malicious intent as a required feature of the offence, the bill has the potential to extend far beyond this.

Helpful versus harmful content?  

We are extremely concerned about the potential of the bill to make illegal a broad range of activities and content directed toward supporting or helping others – outlined by Make Space in previous writing. For example, this may include harm reduction resources that offer detailed anatomical information and first aid guidance to help people make decisions about their self-harm – which could be seen to “assist” someone in their self-harm. Additionally, the bill could also be used to criminalise broader peer support efforts (whether formal or informal) which may include advice on how to reduce harm, deal with wounds, or limit negative feelings about having self-harmed. Working out whether this kind of content is “helpful” or “harmful” is a difficult, if not impossible, line to draw – though many advocating for the bill have presented it in far more binary terms. 

Our experience as well as research has shown that many people face harmful or even cruel consequences when their self-harm is “discovered” or they try to interact with mainstream mental health services. Therefore, having information about covering scars and maintaining boundaries about who does or does not know about your self-harm, could very well be effective and valuable peer support – activities labelled as ‘clearly harmful’ by the Samaritans in their response to the Law Commission’s consultation on the bill. We also know that there is a dearth of appropriate support available when people seek “help” for their self-harm, including from NHS services where there are long waiting lists, stigmatising responses, and a lack of aftercare. The lack of care available elsewhere is often why people turn to online spaces for support in the first place, including accessing or creating self-harm related content. Simply labelling peer support as unhelpful or illegitimate because it (a) has no professional oversight and (b) does not take a cessation-based approach, is an arbitrary or unjustified line to draw. 

The wording of the bill also measures ‘serious self-harm’ against the criminal threshold for Grievous Bodily Harm (GBH) which can include psychological harm, and also notes that self-harm may also occur by omission. This extends the potential remit of the offence further, and may implicate a whole host of practices that may help people live with their distress rather than straightforwardly trying to get them to “stop” actions that may be harmful. 

There are extremely complicated conversations to be had about the “glamorisation” or “glorifying” of self-harm (which was the original proposed wording by the Law Commission, before it was changed to ‘encourage or assist’ in the consultation process). There is, for example, no concrete research that shows that glamorisation is either a legitimate description, or confirms the “contagion” hypothesis upon which worry is based. A recent (and the only) systematic review on the impacts of online self-harm related content on young people showed ambivalent results – that self-harm content could have both harmful and protective effects – and acknowledged that there is no understanding of how and why self-harm related content may lead to harm. There are no systematic reviews or concrete research findings into the effects of self-harm content on adults, even though the bill applies to content directed at any audience irrespective of their age. 

The potential for this law to be applied “generously” cannot be overstated. While there may be explanatory notes accompanying the law and encouraging its narrow application, we have not yet seen them. In any case, explanatory notes are not legally binding, and the exact parameters of the law will have to be worked out by the courts as they explore the plasticity of words such as “encourage”, “assist”, or “serious self-harm”. We are extremely concerned about leaving the courts to decide on such issues, in essence relying on criminal proceedings to determine extremely nuanced and complicated public health matters. Moreover, a court case is not a thought experiment, it concerns real people, and real lives – including those of people who are sharing their experiences, and maybe even methods, of self-harm. Even if it is unlikely that people who are self-harming would be prosecuted under this law, the potential for them to be so (in the absence of requiring malice), is worrying – and must be taken extremely seriously. 

Involvement in the bill: Why it matters 

It is not clear that a single self-harm specific organisation has been consulted on the new law. The self-harm specific offence appears to have arisen from a Law Commission consultation which originally wished to make the offence “glamorising” self-harm; following input from stakeholders during consultation this changed to a recommendation of an offence of ‘encouraging or assisting serious self-harm’. Throughout that consultation, the Samaritans were the only mental health organisation to respond. Primarily, contributors were those who were concerned with the criminal system (such as the Association of Police and Crime Commissioners, and The Magistrates Association), none of which outright endorsed the new self-harm offence, with some even advising against including self-harm in the bill.

Instead, involvement in the consultation process and lobbying around the bill is reminiscent of broader trends on self-harm policy and care – namely, that it is almost entirely led by those whose work concerns suicide prevention/intervention. An example of this is a letter written by a coalition of high-profile mental health organisations who wrote a public letter to the Prime Minister about the bill. The letter was framed entirely around statistics on suicide. To date there are no self-harm specific organisations directly advocating for the bill. This has many effects, not least the conflation of self-harm and suicide in ways that are not helpful. Conflating self-harm with suicide can create a sense of urgency and prioritise cessation-focussed interventions which are not always helpful and can sometimes be dangerous – especially given that self-harm can help some people move away from rather than toward suicide. Moving away from cessation-based approaches is highly complex and invokes a range of ethical and safeguarding considerations – requiring a level of sensitivity and expertise that can only be obtained through the willingness to consider self-harm separate to suicide. 

While preserving opportunities to ‘save lives’ is a goal we share, responding to self-harm is not principally about saving lives (that is the task of suicide prevention). Instead, responding to self-harm is about making lives bearable, of attending to pain with grace and respect, and working out how best to support another even when their distress may feel unfamiliar, confusing, or complicated. Unfortunately the bill will not achieve these things. 

Possible protections: 

In order to protect against unintended consequences of the Online Safety Bill, we call for three actions:

1. “Malicious intent” to be an explicit requirement in the wording of the bill, not just the explanatory notes (which are not legally binding). 
2. Self-harm specific organisations to be included in any further developments on the bill. 
3. Those reporting on or campaigning around the bill must do so with far greater nuance, taking into account the impact of the bill on those who live with self-harm and others trying to support them.  

The proposed wording of the Online Safety Bill creates dangerous avenues for the criminalisation of a vast range of activities that should never be considered illegal. The impact of this cannot be overstated. If we are truly concerned about improving the lives of those who are self-harming – including those who might be generating online content about it – we must think again. The law is a blunt instrument to deal with an incredibly nuanced issue. To simply legislate anyway is ill-conceived and dangerous.

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Authorship/Contact

This article has been prepared by Courtney Buckler (Executive Director) and Dr Veronica Heney (Head of research) at Make Space, and co-signed by the National Survivor User Network (NSUN), and Self injury Support.

For enquiries or further information, please contact Courtney at courtney@makespaceco.org.

Original signatories

Make Space is a user-led collective led by and for people with experience of self-harm. We offer peer-support, training, and develop research/resources on a wide range of issues relating to self-harm.

The National Survivor User Network (NSUN) is a user-led charity and membership organisation of grassroots, community mental health groups and people who have lived experience of mental ill-health, distress, or trauma. We connect, support, and amplify the voices and work of the individuals and groups in our membership.

Self Injury Support is an experience-led UK-wide self-harm support charity which has been providing care, support, training and policy input around self-harm from a user perspective for over 35 years. We offer remote support and free resources, as well as developing regional model projects to demonstrate the impact of peer support in relation to self-harm. We have contributed to all iterations of the NICE guidance on self-harm and NCCMH Self Harm and Suicide Competency Frameworks.

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Co-signatories

If you would like to add your individual or organisational signature to the letter, please fill out this short form or email amy.wells@nsun.org.uk with your name (and if desired, your organisation/role or job title), or if signing as an organisation, your organisation’s name. We will regularly update this page with new signatures.

Organisations

1. Taraki
2. Surviving Work
3. Recovery in the Bin
4. RightLinesUK
5. WISH
6. Medact
7. Battle Scars
8. Gendered Intelligence
9. SLEEC
10. Time and Space
11. Alumina
12. Liberation
13. Headstrong
14. Much More Than A Label – CAPS Collective Advocacy
15. Mind
16. Recovery Devon

Individuals

1. Aodhan Fagan
2. Heather Cobb, WRAP level III facilitator, West Yorks
3. Ria Foster
4. Jessica Stanier, Lecturer (UWE Bristol) and PhD Researcher (University of Exeter)
5. Verity Bell, Barrister
6. Hattie Porter, Occupational Therapist
7. Zoë Haime, University of Bristol, Senior Research Associate
8. Louise Creechan, Durham University, Lecturer in the Literary Medical Humanities
9. Katie Bird
10. Katherine Rowe, Suicide Prevention Programme Manager, Derby and Derbyshire Suicide Prevention Programme
11. Natalya Dell
12. Ruth Braddleson
13. Sue Phillips
14. Dan Warrender, Lecturer in Mental Health Nursing
15. Sahil Ibrahim
16. Jane Haines
17. Amy Chandler, Senior Lecturer, University of Edinburgh
18. Professor Jana Funke, Associate Professor of English and Sexuality Studies, University of Exeter
19. Rebecca Dua
20. Rosie Learmonth
21. Rebecca Milton, PhD Candidate, Centre for Medical & Health Humanities, University of Kent
22. Kirstin Smith
23. Holly Robinson
24. Jess Puplett
25. Charley Baker, Associate Professor of Mental Health, University of Nottingham
26. Jessica Tamsin
27. Layla Taylor
28. Su Goulding
29. Hazel Kerrison
30. Anna Fielding
31. Mike Steel, Independent Advocate
32. Tria Lynn Hall
33. Taslim Hassan, Counsellor/Psychotherapist
34. Grace Stuart
35. Sarah Butler-Boycott
36. Jenny Groves
37. Beth Thomson
38. Laura Autumn Cox
39. Pierre-Malo Mougin
40. Chris Murray
41. Halima Mayat
42. Paula Malone, Registered Mental Nurse
43. Tony Howell
44. Sarah Dockery
45. Christine Guthrie, Communications Officer Battle Scars Self-harm Support Charity
46. Mal, BattleScars
47. Charlotte Watts
48. Rebekah Fulton
49. Michaela Shaw
50. Michael Wootton, Battle Scars
51. Chris England
52. Emily Gardiner, Volunteer Manager at Battle Scars
53. Katrina Lamb
54. Carolyn White, Battle Scars Charity volunteer
55. Lara Dorman
56. Catriona hough, Keyworker
57. Glenn Groves, Co-founder, trustee and treasurer of a self-harm peer support charity Battle Scars
58. Eleanor Lopez
59. Katie Lane
60. Claire Eminson
61. Lauren Stonebanks
62. Magda Bystricka, Nurse
63. Zoe Limbert
64. Ellie Wright
65. Amanda Gray
66. Paul Davey
67. Violet Barasa, Public health expert
68. Joanne Bailey, Peer support worker
69. Katie Hickmott, Lived Experience Influencer – Suicide Prevention/ Intervention
70. Karen Johnson, Trustee and Secretary of Self Harm Peer Support Charity Battle Scars
71. S Roberts
72. Laura Buchenlicht, Lived Experience Trauma Educator
73. Sue Sibbald, Peer Consultant and member of NCISH Project Board
74. Emily Collins
75. Sal Smith
76. Rachel Rowan Olive
77. Munzar Sharif, Trainee Clinical Psychologist, UEL
78. Clare Peat
79. Dr Sarah Chaney, Author of “Psyche on the Skin: A History of Self-Harm”
80. Hel Spandler, Professor of Mental Health, UCLan
81. Chris Millard, Senior Lecturer in the History of Medicine and Medical Humanities, University of Sheffield
82. Rebecca Lissmann, Doctor
83. Janine Davey
84. Cara Gates, Academic researcher in self-harm
85. Evie Procter
86. Karl Jonas Riisnaes
87. Dave Gregson
88. Christina Young, Mental Health Worker (retired)
89. Caroline Townsend, ICB Leeds
90. Hannah Davies
91. Robson Dodd, Alumina Programme Co-Manager (running Alumina for Youthscape)
92. Ruth De Lissandri
93. Rachel Bell
94. Sarah Rowe. Associate Professor, University College London
95. Ann Crossland
96. Sal Ball, Mental health training and consultancy
97. Mandy Foottit, IMHA (Advocate)
98. Natalie Treacher, Mental Health Educator
99. Dr Brigit McWade
100. Cheryl Isher
101. Tim Usher
102. Salena Williams, Clinical Nurse Specialist, Liaison Psychiatry, Bristol Royal Infirmary
103. Lyndsey Jakeman, Complex Needs Worker
104. Seph Mortimer, Expert by Lived Experience
105. Arden Darling
106. Alex Northrop
107. Dr Laura Higson-Bliss, Lecturer in Law, Keele University
108. Sami Goulding, Community Development Worker
109. Sarah Hendy
110. Rowan Davis
111. Fiona Malpass, Hearing Voices Project Manager
112. Helen Leigh-Phippard
113. Chris Young, National Lived Experience Advisor National Collaboration Centre for Mental Health
114. Louisa Harvey, Psychodynamic psychotherapeutic counsellor
115. Natasha Maddison, Psychological Therapist
116. Sophie Miller
117. Madison Carlton
118. Mandy Crandale